Thank you for your interest in receiving a quote from USA Truck Insurance. This form should only take about 5-10 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.

When do you want the policy, or policies, to start?*

Which type of insurance are you looking for?*

Check all that apply.

Other type of insurance*

Primary Insured Name*

Insured Date of Birth*

Email*

Work Phone

Mobile Phone*

Can we text you?*

Yes

No

Business Information

Legal Business Name*

DBA

Entity Type*

FEIN

Website

Business Address*

Street Address City State Zipcode

Mailing Address*

Same as Business Address

Year Business Started*

Years of experience operating this business?*

Years of experience in this field?*

Is this business affiliated with a franchise?

No

Yes

USDOT#

MC#

TXDOT Certificate #

Number of Owners

Additional Business Owners

Owner 2

2. Owner Name*

First Last

2. Owner Date of Birth*

2. Owner Phone*

2. Owner Email*

2. Owner Role

Owner 3

3. Owner Name*

First Last

3. Owner Date of Birth*

3. Owner Phone*

3. Owner Email*

3. Owner Role

Owner 4

4. Owner Name*

First Last

4. Owner Date of Birth*

4. Owner Phone*

4. Owner Email*

4. Owner Role

Vehicles

Number of Vehicles*

Are all vehicles garaged at the business address?*

Yes

No

Are all vehicles titled in the name of the business?*

Yes

No

Vehicle 1

1. VIN*

1. Year*

1. Make*

1. Model*

1. Gross Vehicle Weight*

1. Radius of Travel*

1. Garaging Zip*

1. Collision Deductible

1. Comprehensive Deductible

1. Does this vehicle have permanently attached equipment?

No

Yes

1. Value of attached equipment

Vehicle 2

2. VIN*

2. Year*

2. Make*

2. Model*

2. Gross Vehicle Weight*

2. Radius of Travel*

2. Garaging Zip*

2. Collision Deductible

2. Comprehensive Deductible

2. Does this vehicle have permanently attached equipment?

No

Yes

2. Value of attached equipment

Vehicle 3

3. VIN*

3. Year*

3. Make*

3. Model*

3. Gross Vehicle Weight*

3. Radius of Travel*

3. Garaging Zip*

3. Collision Deductible

3. Comprehensive Deductible

3. Does this vehicle have permanently attached equipment?

No

Yes

3. Value of attached equipment

Vehicle 4

4. VIN*

4. Year*

4. Make*

4. Model*

4. Gross Vehicle Weight*

4. Radius of Travel*

4. Garazing Zip*

4. Collision Deductible

4. Comprehensive Deductible

4. Does this vehicle have permanently attached equipment?

No

Yes

4. Value of attached equipment

Vehicle 5

5. VIN*

5. Year*

5. Make*

5. Model*

5. Gross Vehicle Weight*

5. Radius of Travel*

5. Garaging Zip*

5. Collision Deductible

5. Comprehensive Deductible

5. Does this vehicle have permanently attached equipment?

No

Yes

5. Value of attached equipment

Vehicle 6

6. VIN*

6. Year*

6. Make*

6. Model*

6. Gross Vehicle Weight*

6. Radius of Travel*

6. Garaging Zip*

6. Collision Deductible

6. Comprehensive Deductible

6. Does this vehicle have permanently attached equipment?

No

Yes

6. Value of attached equipment

Drivers

Primary Insured: Drivers License Number*

Primary Insured: Drivers License State*

Commercial License? (CDL)

No

Yes

Year CDL Issued

Number of Additional Drivers*

Let's add 8 of your drivers now. We will contact you to get your additional drivers information.

Do any of your drivers take the vehicle(s) home at night?*

No

Yes

Driver 1

1. Name*

First Last

1. Date of Birth*

1. Drivers License #*

1. Drivers License State*

1. Commercial License? (CDL)

No

Yes

1. Year CDL Issued

1. Hire Date

Driver 2

2. Name*

First Last

2. Date of Birth*

2. Drivers License #*

2. Drivers License State*

2. Commercial License? (CDL)

No

Yes

2. Year CDL Issued

2. Hire Date

Driver 3

3. Name*

First Last

3. Date of Birth*

3. Drivers License #*

3. Drivers License State*

3. Commercial License? (CDL)

No

Yes

3. Year CDL Issued

3. Hire Date

Driver 4

4. Name*

First Last

4. Date of Birth*

4. Drivers License #*

4. Drivers License State*

4. Commercial License? (CDL)

No

Yes

4. Year CDL Issued

4. Hire Date

Driver 5

5. Name*

First Last

5. Date of Birth*

5. Drivers License #*

5. Drivers License State*

5. Commercial License? (CDL)

No

Yes

5. Year CDL Issued

5. Hire Date

Driver 6

6. Name*

First Last

6. Date of Birth*

6. Drivers License #*

6. Drivers License State*

6. Commercial License? (CDL)

No

Yes

6. Year CDL Issued

6. Hire Date

Driver 7

7. Name*

First Last

7. Date of Birth*

7. Drivers License #*

7. Drivers License State*

7. Commercial License? (CDL)

No

Yes

7. Year CDL Issued

7. Hire Date

Driver 8

8. Name*

First Last

8. Date of Birth*

8. Drivers License #*

8. Drivers License State*

8. Commercial License? (CDL)

No

Yes

8. Year CDL Issued

8. Hire Date

Commodities & Historical Counts

Commodities Hauled*

Please list all commodities you normally haul. Click the "+" sign to add more rows. Please limit "general freight" to 10%. Carriers ask for specific commodities.

% of all loads should add up to 100%.

Commodity Name

% of All Loads

Building and Property Information

My business location is*

Leased Property

Owned Property

Work From Home

Do you need coverage for the building?*

Yes

No

Have you made any tenant improvements?*

Yes

No

In the future

How much tenant improvement coverage do you need?

Square footage of your business*

Building Information

Year Built*

Number of stories of the building*

Construction Type*

Roof Type*

Other construction type*

Other roof type*

Has there been any updates to the roof, plumbing, or electrical?*

No

Yes

I don't know

Year Roof Updated?

Year Plumbing Updated?

Year Electrical Updated?

Business Description

Please describe the nature of your business*

Claims Information

Have you had any claims or losses in the last 5 years?*

No

Yes

What was the date, amount paid, and description of each loss or claim*

Current Insurance

Has your business been cancelled or non-renewed in the last 4 years?*

No

Yes

Have you ever filed for bankruptcy?*

No

Yes

Bankruptcy: Please describe when and why*

Do you have ANY business insurance currently?*

No

Yes

Name of current insurance carrier?*

Expiration date of current policy*

Why are you looking for a new quote?

Current total insurance premium?

Current Policies

Drop files here or

Accepted file types: pdf, Max. file size: 5 MB, Max. files: 10.

Liability Limits (Optional)

What is the Liability limit requested?

Do you need any Business Personal Property coverage?*

Yes

No

Not sure, let's discuss

How much Business Personal Property coverage do you want?

Are you interested in Loss of Use / Business Income coverage?*

Yes

No

Not sure, let's discuss

Garage & Dealers Information

List the percentage of the work you provide for each section below.

Where work is performed. Total must equal 100%.

Percent of work performed at Your Shop

% at Your Shop

Percent of work performed at Customer's Location

% at Customer's Location

Percent of work performed at Other

% Other

0%

Please describe Other Location

Type(s) of work performed (in percent). Total must equal 100%.

Type of Work: Body/Paint

% Body/Paint

Type of Work: Brakes, Transmission or Suspension

% Brakes, Transmission or Suspension

Type of Work: Electrical

% Electrical

Type of Work: Mechanical

% Mechanical

Type of Work: Muffler/Radiator

% Muffler/Radiator

Type of Work: Oil Change

% Oil Change

Type of Work: Roadside Assistance

% Roadside Assistance

Type of Work: Safety Inspection

% Safety Inspection

Type of Work: Tires/Wheels

% Tires/Wheels

Type of Work: Tune Up

% Tune Up

Type of Work: Wash/Detail

% Wash/Detail

Type of Work: Welding

% Welding

Type of Work: Other

% Other (Upholstery, frame work, body work, window tint, windows, cleaning trailer, stereo system, etc.)

0%

Please describe Welding type of work performed*

Please describe Other type of work performed*

Do you provide any off-site services or mobile services?*

No

Yes

What is the maximum miles away from your business that you offer your services?*

Dealer Sales Questions

How many Dealer Plates do you have?*

Number of Repairer/Transporter plates owned by you?

Number of vehicles sold annually*

Number held for sale (Average #)*

Number held for sale (Maximum #)*

Number of vehicles sold on internet auction

Number of vehicles sold on consignment

Do you sell "salvage titled" vehicles?*

No

Yes

Yes: How much structural repair done?*

Additional Insured Information (Optional)

Do you have anyone that needs to be listed as Additional Insured?

No

Yes

Additional Insured Information. (i.e. Name & Address)

You may upload your additional insured documents using the upload field below.

Additional Insured Document(s)

You may upload up to 10 PDF documents. If you have more documents you can send them to your agent after they contact you.

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 10.

Additional Comments and/or Current Policy Upload (Optional)

Any additional comments

Any Additional Documents

Drop files here or

Accepted file types: pdf, Max. file size: 8 MB, Max. files: 5.

Wrapping Up

Would you like a quote from a specific agent?

How were you referred to us?

Consent*

Like most insurance agencies, we use information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.

I Agree

Would you like to create a user account to manage your submissions?*

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Username*

Password*

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Authorized Person's Name*

First Last

Authorized Signature*

Phone

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Business Information

Additional Business Owners

Owner 2

Owner 3

Owner 4

Vehicles

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Drivers

Driver 1

Driver 2

Driver 3

Driver 4

Driver 5

Driver 6

Driver 7

Driver 8

Underwriting

Primary Coverage Options

Underwriting

Commodities & Historical Counts

Business Information Continued

Building and Property Information

Building Information

Business Description

Customer Data

Claims Information

Current Insurance

Liability Limits (Optional)

Garage & Dealers Information

Garage & Dealers Information

Dealer Sales Questions

Additional Insured Information (Optional)

Additional Comments and/or Current Policy Upload (Optional)

Wrapping Up

USA Truck Insurance

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